PatientInfo

Is child enrolled in school

Intervention plan

Consanguinity

No

Neck holding

Food preferences

HR

Neuropsychiatric condition

Place of Birth

Institutional

Hospitalization

Tactile

PatientId

97532ab9-ab72-4569-bcd3-3dda59d85d70

FollowUpId

9f8c5f8f-680e-447d-a54b-6352c28a6244

Child's Name

Raksha

Age

1 Year 1 Month 4 Days

Gender

Female

DOB

2025-07-08

Mother’s age (years)

Mother’s education

Mother’s occupation

Father’s age (years)

Father’s education

Father’s occupation

Type of family

Number of family members

Number of siblings

Details of siblings (Age and sex)

Address

Contact

8827928843

Referred By

Informant

Chief concerns

Delayed milestones, reduced movement of right hand

Duration of symptoms

Concerns noticed by school (if any)

Strengths of child

Eye contact

Sustained

Interaction

Quality of Interaction

age-appropriate

Repetitive behaviors (RRBs)

If yes- Details

Patterned behavior or activities

If yes- Details

Others

Details:

Impression

Hopes from the consultation